Session 23. Fiberoptic Intubation/Bronchoscopy Flashcards
fiberoptic power cord
light source
video
fiberoptic channel port
O2
meds
suctioning
fiberoptic scope eyepiece
video adapter
direct viewing (older scopes)
control section/lever
moves tip up and down relative to scope
directionality of fiberoptic scope
counterclockwise = left
clockwise = right
what hand do you hold fiberoptic scope
left
diopter ring
focuses view
insertion cord avg length
600mm
(range: 500-650mm)
fiberoptic light source
battery powered source
LED
or Incadescnet
moving lever down
moves tip up
moving lever up
moves tip down
fiberoptic scope cost
20K
cost to fix broken fiberoptic scope
9K
fiberotic strands are
glass
(dont bend)
fiberoptic indications
anticipated difficult tracheal intubation
anticipated difficult mask ventilation
very small mouth opening
unstable cervical spine
upper airway trauma (false passage)
tube placement verification (double lumen)
fiberoptic absolute contraindications
lack of time
fiberoptic relative contratindications
active profuse bleeding
active vomiting
uncooperative pt
what might obscure visualization of fiberoptic scope?
secretions
blood
vomit
oral fiberoptic mthod
facial/skull injury
gagging likely
nasal fiberoptic method
small mouth opening
conduit to guide scope
sedated fiberoptic method
deep sedation
- ketamine
- glyco
- precedex
hypoventilation/apenic risk
what pts are best for sedated fiberoptic scopes
uncooperative pts
awake fiberoptic method
most preferred
maintains ventilation
preserves airway reflexes
equiment for fiberoptic scope
sedation/pre-meds
LMA/ETT/CMAC
localization
bronchoscope
supp O2
ENT on standby
what do you premedicate w/ prior to fiberoptic scope
glycopyrrolate (0.2mg)
15-20min prior
best drugs for fiberoptic scope
glycopyrrolate (antisalagogoue)
precedex
versed
ketamine
other drugs for fiberoptic scope
propofol
remi
what is the most important step for fiberoptic scope prep?
localization
localization (FO prep)
nebulize 4% lidocaine during pre-ox
nasal: phenylephine/lido in nares
oral: incrementally spray onto tongue/oropharynx
what is easily stimulated in the airway?
vocal cords
carina
when do you use fiberoptic airway?
oral route
type of fiberoptic airways
ovassapian
williams
bermann II
what can happen if you run scope into carina?
coughing
tracheal rings are located
anterior
pt education for F.O scope
not comfortable experience
give hand to hold
how much lido should you give for F.O scope?
be mindful of toxic dose
ensure accurate total documented to provide to surgeon
how does lidocaine work>
Na+ antagonist
too much lidocaine can cause
decreased HR
lidocaine toxic dosages
4 mg/kg
7mg/kg w/epi
F.O. suction port
not helpful due to small size
best to avoid secretions
